Feasibility of a pharmacy-based overdose prevention program in rural/suburban NY

纽约州农村/郊区基于药房的药物过量预防计划的可行性

• 批准号: 10198893
• 负责人: CRYSTAL FULLER LEWIS
• 金额: $ 22.42万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10198893
• 关键词: Address; Adoption; Advocate; Attitude; Blood Pressure; Characteristics; Chronic Disease; Communities; Computer Assisted; County; Coupling; Data; Data Analyses; Death Rate; Development; Diffusion; Diffusion of Innovation; Emergency Department patient; Emergency department visit; Epidemic; Equipment and supply inventories; Event; Foundations; Funding; Geographic Locations; Geography; Goals; HIV; Health; Human immunodeficiency virus test; Indiana; Individual; Institutes; Insurance; Intervention; Interview; Knowledge; Latinx; Link; Literature; Medicaid; Mental Health; Methods; Municipalities; Naloxone; Naloxone Training; New Mexico; New York; Ohio; Opioid; Outcome; Overdose; Patients; Perception; Persons; Pharmaceutical Preparations; Pharmaceutical Services; Pharmacists; Pharmacy facility; Policies; Prevention program; Privatization; Process; Public Health; Reporting; Research; Role; Rural; Screening Result; Services; Solid; Statutes and Laws; Stigmatization; Surveys; Syringes; Telephone; Training and Education; Vaccination; Work; base; design; experience; innovation; interest; medical schools; opioid epidemic; opioid misuse; opioid mortality; opioid overdose; opioid use; overdose death; overdose prevention; overdose risk; payment; programs; racial diversity; response; rural counties; screening; service programs; service utilization; social disparities; social stigma; suburb; theories; uptake

The purpose of this mixed-methods exploratory study is to (1) investigate the support and diffusion of naloxone pharmacy services that utilize a standing order, and (2) assess feasibility of an expanded public health role for naloxone-registered pharmacists to help increase uptake of pharmacy-acquired naloxone in rural /suburban New York (NY). The U.S. opioid overdose crisis has led to legislation in 49 states allowing naloxone (i.e., opioid overdose reversal medication) to be dispensed through a non-patient specific prescription or “standing order”. In New York State (NYS), over 2,600 pharmacies are registered to participate in the Opioid Overdose Prevention Program (OOPP) which allows use of a standing order to dispense naloxone. Yet, pilot data as well as anecdotal evidence suggests that pharmacy-acquired naloxone is infrequent in NY, and either non-existent or limited in suburban/rural counties where burden of opioid-related overdose deaths is highest. Recent reports have identified pharmacy reimbursement challenges, patient affordability, and patient-anticipated stigma dampening naloxone demand as ongoing barriers – even where extensive pharmacy-targeted overdose prevention training and education have taken place. The goal of this study is to explore barriers (eg. opioid- related stigma) and facilitators (eg. use of a state-funded co-pay reimbursement program) of pharmacy naloxone services in NY suburban/rural counties where pharmacy dispensation is low or non-existent, and overdose rates are high. In addition, we will explore pharmacist interest in coupling naloxone services with other non-stigmatizing pharmacy services to help increase uptake and support of pharmacy naloxone services (a successful stigma- reducing intervention from our prior work in the HIV arena). The diffusion of innovation provides a theoretical framework to examine adoption and rejection of pharmacy naloxone services. Specifically, we will identify pharmacist/pharmacy characteristics, experiences, and practices associated with: (i) naloxone registration status (Aim 1a), (ii) support for pharmacy naloxone services, and (iii) support for coupling naloxone with other non- stigmatizing pharmacy services (Aim 1b) among 1,000 naloxone-registered and non-registered pharmacists. We will also conduct in-depth interviews to contextualize the individual-, pharmacy-, and policy-level barriers/facilitators of pharmacy naloxone services among key stakeholders: (a) pharmacists (n=24); (b) opioid- related ED patients (n=20); and (c) community advocates/health officials (n=16) (Aim 2). We will target 8 counties with the highest opioid overdose rates in NYS to administer a pharmacist computer-assisted phone survey (online, and/or in-person also available), and 2 of those counties will be selected to conduct in-depth interviews where our research capacity has been established. Survey and qualitative data will be analyzed and triangulated for final data interpretation. Proposal significance and innovation is high given: (1) the opioid crisis and similar pharmacy naloxone policy across U.S., (2) the generalizability gained by targeting geographically and racially diverse non-urban areas, and (3) the potential for a pharmacy-based intervention that addresses stigma to follow.

这项混合方法探索性研究的目的是（1）研究纳洛酮的支持和扩散 利用常规指令的药房服务，以及 (2) 评估扩大公共卫生作用的可行性 纳洛酮注册药剂师帮助增加农村/郊区对药房获得的纳洛酮的吸收新 约克（纽约州）。美国阿片类药物过量危机导致 49 个州立法允许使用纳洛酮（即阿片类药物）。 过量逆转药物）通过非患者特定处方或“常规订单”进行分配。 纽约州 (NYS) 已有 2,600 多家药店注册参与阿片类药物过量预防 允许使用常规指令来分配纳洛酮的计划（OOPP）然而，试点数据以及轶事。 有证据表明，从药房获得的纳洛酮在纽约并不常见，并且要么不存在，要么仅限于 最近的报告显示，与阿片类药物相关的过量死亡负担最高的郊区/农村县。 确定了药房报销挑战、患者负担能力和患者预期的耻辱 抑制纳洛酮的需求是持续的障碍——即使是在大量针对药房的过量用药的情况下 本研究的目的是探索障碍（例如阿片类药物）。 药房纳洛酮的相关耻辱）和促进者（例如使用国家资助的共同支付报销计划） 纽约郊区/农村县的服务，这些县的药房配药量很少或根本不存在，并且用药过量率较高 此外，我们将探索药剂师将纳洛酮服务与其他非污名化服务相结合的兴趣。 药房服务，帮助增加纳洛酮药房服务的采用和支持（一个成功的耻辱 减少我们之前在艾滋病毒领域的工作的干预）。创新的扩散提供了一个理论。 具体来说，我们将确定采用审查和拒绝药房纳洛酮服务的框架。 与以下相关的药剂师/药房特征、经验和做法：(i) 纳洛酮注册状态 （目标 1a），（ii）支持药房纳洛酮服务，以及（iii）支持纳洛酮与其他非 在 1,000 名纳洛酮注册和非注册药剂师中污蔑药房服务（目标 1b）。 我们还将进行深入访谈，以了解个人、药房和政策层面的情况 主要利益相关者中纳洛酮药房服务的障碍/促进因素： (a) 药剂师 (n=24)； (b) 阿片类药物 相关 ED 患者 (n=20)；以及 (c) 社区倡导者/卫生官员 (n=16)（目标 2）。 纽约州阿片类药物过量率最高的药剂师进行计算机辅助电话调查 （也可以在线和/或亲自进行），并且将选择其中 2 个县进行深入访谈 我们的研究能力已经建立，调查和定性数据将被分析和三角测量。 鉴于以下因素，最终数据解释的意义和创新性很高：（1）阿片类药物危机和类似事件。 美国各地的纳洛酮药房政策，(2) 通过针对地理和种族目标获得的普遍性 多样化的非城市地区，以及（3）基于药房的干预措施解决耻辱问题的潜力。

项目成果

Rural and small metro area naloxone-dispensing pharmacists' attitudes, experiences, and support for a frontline public health pharmacy role to increase naloxone uptake in New York State, 2019.

2019 年纽约州农村和小都市区纳洛酮配药药剂师对一线公共卫生药房角色的态度、经验和支持，以增加纳洛酮的吸收。

• 发表时间: 2021
• 影响因子: 3.9
• 作者: Tofighi, Babak;Lekas, Helen;Williams, Sharifa Z;Martino, Daniele;Blau, Chloe;Lewis, Crystal F
• 通讯作者: Lewis, Crystal F

Internet use and uptake of a web-based prevention and risk reduction intervention for persons who use drugs in New York City - WebHealth4Us study (2013-2016).

纽约市吸毒者的互联网使用情况以及基于网络的预防和风险降低干预措施的采用 - WebHealth4Us 研究（2013-2016 年）。

• 发表时间: 2022
• 影响因子: 3.5
• 作者: Lewis, Crystal Fuller;Williams, Sharifa Z;Tofighi, Babak;Lekas, Helen;Joseph, Adriana;Rivera, Alexis;Amesty, Silvia C
• 通讯作者: Amesty, Silvia C